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25-11-2024 | Breast Cancer Free for a limited time

“When Less is More”: Paradigm Shifts in Radiation Treatment for Early-Stage Breast Cancer

Authors: Sylvia Rhodes, David Gibbes Miller, Fumiko Chino

Published in: Current Treatment Options in Oncology

Opinion Statement

Recent advancements in the treatment of early-stage breast cancer have significantly shifted the radiotherapy landscape. Traditionally, the standard of care included lumpectomy followed by endocrine therapy and 3–5 weeks of adjuvant radiation targeting the entire unilateral breast. This review summaries modern trials, emphasizing data reported since 2019 that have changed radiation treatment paradigms. Ultra-hypofractionated treatment regimens have enabled radiation oncologists to deliver the total radiation dose in as few as 5 treatments over 1 week for select patients. Partial breast irradiation, treating only the breast tissue nearest to the lumpectomy cavity, has also emerged as an effective and well-tolerated treatment. Furthermore, a growing body of evidence supports the safety of omitting radiation completely for certain older adults with low-risk disease. Ongoing research in areas such as precision cancer care, treatment de-escalation, and toxicity prevention and management reflects a broader shift toward shared decision-making in medicine and individually tailored treatment paradigms. As research progresses, treatment options will continue to evolve. Advances in radiation oncology will give the oncology team a growing array of tools to custom treatment plans to individual patient risks and toxicity concerns. Knowledge of radiation advances should be used to facilitate shared decisions with patients about the balance of treatment efficacy, toxicity, and quality of life, with the ultimate goal of promoting high-quality, personalized, and patient-centered cancer care.

Per AJCC 8th Edition staging, N1 disease also includes clinically negative but pathologically positive internal mammary lymph nodes, though this is rarely seen clinically.

A whole breast treatment field typically extends medially to the lateral edge of the sternum, laterally to include all breast tissue, inferiorly to 1-2 cm below the inframammary fold, superiorly to the inferior edge of the clavicular head, posteriorly to the mid-axillary line or anterior edge of the latissimus dorsi, and anteriorly beyond the skin surface. Beams are angled to maximize coverage to this area while minimize lung and heart dose.

Regional nodal irradiation is also typically utilized in patients who receive adjuvant radiotherapy after a mastectomy. Post-mastectomy radiotherapy is generally reserved for patients with T3-T4 disease, node positive disease without axillary lymph node dissection (ALND), and/or high-risk node positive disease after ALND. These patients typically would not be considered to have early-stage breast cancer and therefore do not necessarily fall under the scope of this review.

The Harvard Breast Cosmesis Scale is a four-point Likert scale used to evaluate the cosmetic appearance of breasts after cancer treatment. The scale categorizes cosmetic outcomes as “excellent,” “good,” “fair,” or “poor,” based on criteria such as symmetry, shape, texture, and skin color change.

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Title: “When Less is More”: Paradigm Shifts in Radiation Treatment for Early-Stage Breast Cancer
Authors: Sylvia Rhodes
David Gibbes Miller
Fumiko Chino
Publication date: 25-11-2024
Publisher: Springer US
Keywords: Breast Cancer
Radiotherapy
Breast Cancer
Gynecological Oncology
Published in: Current Treatment Options in Oncology
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI: https://doi.org/10.1007/s11864-024-01253-w

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Targeted Therapy
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In this webinar, Professor Martin Dreyling and an esteemed international panel of CAR T-cell therapy experts discuss the latest data on the safety, efficacy, and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL.

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Keynote series | Spotlight on menopause

Springer Medicine

“When Less is More”: Paradigm Shifts in Radiation Treatment for Early-Stage Breast Cancer

Opinion Statement

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Keynote series | Spotlight on menopause

Springer Medicine

Opinion Statement

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Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma